Specialist ENT HASHIMOTOS THYROIDITIS

HASHIMOTO’S THYROIDITIS

Synonyms:

➣ Struma Lymphomatosa.

➣ Chronic lymphocytic thyroiditis.

➣ Hashimoto’s disease.

It is a common autoimmune disorder seen predominantly in women. Considered to be autoimmune since it coexists with other autoimmune conditions and is associated with presence of antithyroid antibodies in the serum.

Aetiology:
  1. Genetic factor: It is associated with-
    • CTLA-4 (Cytotoxic T-lymphocyte Antigen-4) gene polymorphisms.
    • HLA-DR5 gene.
  2. Environmental factors.
  3. Family history: Family history of having another autoimmune disease like celiac diseasetype 1 diabetesvitiligo, and alopecia.

Pathophysiology:

Specialist ENT Screenshot 2020 12 03 ORAL CAVITY AND PHARYNX SEMIFINAL BS

Clinical presentation:

  1. Common in women who have goitre and hypothyroidism.
  2. There is accompanying weight gainfeeling tiredconstipationdepression, and general pains.
  3. Usually not associated with any other symptoms.
  4. The enlargement in the thyroid is diffuse and less commonly nodular or asymmetrical.
  5. Carcinoma should be suspected when thyroiditis is associated with one or more nodules.
Specialist ENT Screenshot 2020 12 03 ORAL CAVITY AND PHARYNX SEMIFINAL BS

Diagnosis:

  1. Detecting elevated levels of  anti-thyroglobulin antibodies (anti-Tg) and anti-thyroid peroxidase antibodies (TPOAb) in the serum.
  2. Thyroid function studies are usually normal. 
  3. Radioiodine uptake scans show decreased uptake with patchy distribution.
Treatment:
  1. Usually hypothyroidism caused by Hashimoto’s thyroiditis is treated with thyroid hormone replacement agents such as levothyroxinetriiodothyronine or desiccated thyroid extract. A tablet taken once a day generally keeps the thyroid hormone levels normal.
  2. Surgery is indicated when:

      a) When mass does not get suppressed by thyroxine therapy.

      b) When the gland continues to increase despite thyroxine.

      c) When FNAC is suggestive of malignancy.

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